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Objective:To analyze the clinical, imaging and pathological characteristics of pleomorphic xanthoastrocytoma (PXA), and to explore the effective treatment of PXA.Methods:A total of 25 patients with PXA admitted to our hospital from July 1, 2012 to December 1, 2019 were chosen in our study. Their clinical manifestations, imageology features, pathology features, treatments, and prognoses were retrospectively analyzed.Results:Headache ( n=12) and epilepsy ( n=8) were the most common first symptoms in 25 patients. The tumors in 8 patients were located in the parietal lobe, 6 were in the temporal lobe, and 6 were in the frontal lobe. Among the pathological results, the average positive rate of cell proliferation antigen Ki-67 and P53 in patients with WHO grading II was 6.4% and 21.2%, respectively; the average positive rate of Ki-67 and P53 in patients with WHO grading III was 22.2% and 48.3%, respectively. Synaptophysin protein was confirmed in 12 of the 15 patients. Twenty patients were followed up for 31 months after surgery; 19 survived; 9 had no tumor recurrence or residue, including 8 with WHO grading II and one with WHO grading III. Conclusion:Pathological result play an important role in PXA diagnosis; the prognosis of patients with WHO grading II is obviously better than that of patients with WHO grading III.
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Objective:To explore the surgical outcomes of focal cortical dysplasia (FCD) patients with "difficult to locate" intractable epilepsy and their influencing factors.Methods:Thirty-five FCD patients with "difficult to locate" intractable epilepsy, underwent surgical treatment after intracranial electroencephalogram (iEEG) evaluation in our hospital from January 2011 to December 2018, were chosen in our study. Engel grading was used to evaluate the surgical efficacies of these patients, and they were divided into a satisfied efficacy group (Engel grading I) and an incomplete satisfied efficacy group (Engel grading II-IV). The clinical data of patients from the 2 groups were compared. Multivariate Logistic regression analysis was performed to explore the influencing factors for surgical outcomes of FCD patients with "difficult to locate" intractable epilepsy.Results:Of these 35 patients, 26 patients (74.3%) achieved satisfied efficacy, and 4 had incomplete satisfied efficacy. As compared with those in the satisfied efficacy group, patients in the incomplete satisfied efficacy group had significantly lower total resection rate of epileptogenic foci ( P<0.05). Multivariate Logistic regression analysis showed that incomplete resection of epileptogenic foci was the influencing factor for surgical outcomes of FCD patients with "difficult to locate" intractable epilepsy ( P=0.014, OR=0.050, 95%CI: 0.005-0.547). Conclusion:The FCD patients with "difficult to locate" intractable epilepsy can achieve satisfactory results by surgical resection of epileptogenic zones after iEEG monitoring; these FCD patients with "difficult to locate" intractable epilepsy with incomplete resection of epileptogenic foci often have poor surgical outcomes.
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OBJECTIVE@#To evaluate the feasibility of applying intracranial lead reconstruction in deep brain stimulation (DBS) therapy for Parkinsonism.@*METHODS@#We retrospectively collected the clinical data from 27 patients with Parkinson's disease (PD), who received bilateral subthalamic nucleus (STN) DBS therapy between January, 2016 and December, 2017. According to the position of the selected optimal stimulating contact of the implanted leads, the patients were divided into group A with the stimulating contacts of the bilateral leads in the STN, group B with unilateral stimulating contacts in the STN, and group C with bilateral stimulating contacts outside the STN. All the patients were assessed for improvement using Hoehn-Yahr stage, the third part of United Parkinson's Disease Rating Scale (UPDRS Ⅲ), Schwab and England Activities of Daily Living (SE-ADL), and L-dopa equivalent daily dose (LEDD). The consistency between the optimal stimulating contact selected by lead reconstruction and that by standard postoperative programming procedure was also evaluated.@*RESULTS@#The patients in all the 3 groups showed postoperative improvements in Hoehn-Yahr stage, UPDRS Ⅲ score, SE-ADL score, and LEDD in the medication-off state. But at 12 months of the follow-up, such improvements were maintained only in the patients of group A. The optimal stimulating contacts selected by lead reconstruction and standard postoperative programming procedure had a matching rate of up to 77.78% (42/54), and the coordinates of the optimal contacts selected by the two methods showed no significant difference.@*CONCLUSIONS@#Intracranial lead reconstruction facilitates the study of the association between the implant site of the leads and the clinical outcome of DBS therapy for PD and allows the precise selection of the optimal contact of the implanted leads in postoperative programming of DBS.
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Humans , Activities of Daily Living , Deep Brain Stimulation , Parkinson Disease , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To explore the related factors affecting postoperative pneumonia in patients with cavernous cerebrovascular malformation (CCM).MethodsClinical data of 151 CCM patients admitted to our hospital from January 2010 to January 2017 were retrospectively collected. Patients were divided into postoperative pneumonia group (n=11) and postoperative non-pneumonia group (n=140) according to the occurrence of postoperative pneumonia. Univariate Logistic regression analysis, multivariate Logistic regression analysis and receiver operating characteristic (ROC) curve were used to screen the relevant factors influencing the occurrence of postoperative pneumonia in CCM patients and evaluate the predictive value of relevant factors in postoperative pneumonia.ResultsAs compared with patients from postoperative non-pneumonia group, patients from postoperative pneumonia group had significantly increased modified Rankin scale (mRS) scores and significantly higher percentage of CCM combined with hemorrhage, and significantly decreased Glasgow coma scale (GCS) scores (P<0.05). Multivariate Logistic regression analysis showed that preoperative GCS scores (OR=4.75, 95％CI: 1.14-19.80,P=0.032) and mRS scores (OR=15.61, 95％CI: 3.22-75.58,P=0.001) were independent factors influencing the occurrence of postoperative pneumonia. ROC curve showed that the sensitivity and specificity of mRS scores≥4 to predict postoperative pneumonia were 45.5％ and 95.7％, respectively, and the sensitivity and specificity of GCS scores≤13 to predict postoperative pneumonia were 54.5％ and 85.7％, respectively.ConclusionFor CCM patients with preoperative GCS scores≤13 or mRS scores≥4, more attention should be paid to perioperative lung management and occurrence of postoperative pneumonia should be vigilant.
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As a newly discovered type of oxygen-carrying protein,neuroglobin(Ngb) is mainly presented in neurons in the form of monomers,which is closely related to oxygen supply in brain tissues.Neuronal apoptosis and necrosis caused by central nervous system injury aggravate the degrees of cerebral ischemia and hypoxia,and further induce the Ngb high expression,thus exerting a significant neuroprotective effect.As oxygen receptor and oxygen-carrying protein,Ngb can exert endogenous neuroprotective effects under hypoxic conditions and reduce the degree of hypoxic-ischemic brain damage.In this paper,we summarize the structure and function of Ngb,and explore the expression changes and mechanism of Ngb in various types of central nervous system injury.
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Objective To explore whether receptor interacting protein (RIP)1/RIP3 pathways participate in glutamate induced cell death in HT-22 neuronal cells and investigate the potential neuroprotection ofnecrostatin-1 in glutamate induced cell death in HT-22.Methods (1) In vitro cultured mouse hippocampal neuronal HT-22 cells were divided into control group,zVAD group,necrostatin-1 (Nec-1) group,glutamate group,glutamate+zVAD group,glutamate+zVAD+Nec-1 group and glutamate+Nec-1 group;they were treated with zVAD,Nec-1 and glutamate at the final concentrations of 20 μmol/L,30 μmol/L and 3 mmol/L for 24 h.Cell viability was detected using a luminescence-based commercial kit Cell Titer-Glo (CTG).Necrotic cell death was measured by propidium iodide (PI) and HE stainings.(2) HT-22 cells were divided into control group Ⅰ,glutamate group Ⅰ and glutamate+Nec-1 group Ⅰ;MitoSox Red was used to detect mitochondrial reactive oxygen species (ROS) level.(3) HT-22 cells were divided into control group Ⅱ,glutamate group Ⅱ and glutamate+tertiary butyl-hydroxyanisole (BHA) group;the final concentration of BHA was 100 μmol/L;necrotic cell death was measured by PI and HE stainings after 24 h of treatment.(4) HT-22 cells were divided into RIP3 siRNA and control group Ⅲ,and then,they were transfected with RIP3 siRNA or negative siRNA,respectively;the RIP3 protein expression was determined by Westem blotting after 72 h of treatment.(5) HT-22 cells were divided into negative siRNA+Control,RIP3 siRNA,negative siRNA+glutamate and RIP3 siRNA+glutamate groups;the cells were transfected with RIP3 siRNA or Negative siNRA,respectively;48 h later,the glutamate groups were treated with 3 mmol/L glutamate;PI positive cells and cell viability were measured by PI and HE stainings and CTG at 24 h after glutamate treatment.Results (1) As compared with control group,percentage of PI positive cells was greatly increased and cell viability was decreased in glutamate group and glutamate+zVAD group,with statistically significant differences (P＜0.05);as compared with those in the glutamate group,percentage of percentage of PI positive cells was was significantly decreased and cell viability was statistically increased in glutamate+Nec-1 group (P＜0.05).(2) ROS level in HT-22 cells of the glutamate group was significantly increased than that in the control group Ⅰ (P＜0.05);however,ROS level in HT-22 cells of glutamate+Nec-1 group Ⅰ was significantly decreased than that in glutamate group Ⅰ (P＜0.05).(3)Percentage of PI positive cells in the glutamate group Ⅱ was significantly higher than that in the control group Ⅱ (P＜0.05),and that in the glutamate+BHA group was statistically lower than that in the glutamate group Ⅱ (P＜0.05).(4) The RIP3 protein expression in the RIP3 siRNA group was obviously down-regulated as compared with that in the control group Ⅲ.(5) As compared with those in the negative siRNA group,percentage of PI positive cells was statistically increased and cell viabilities were statistically decreased in glutamate group (P＜0.05);however,percentage of PI positive cells was significantly decreased and cell viability was significantly increased in RIP3 siNRA+glutamate group as compared with those in the glutamate group (P＜0.05).Conclusion RIP1/RIP3 pathway and ROS might mediate glutamate induced cell death in HT-22 cells.
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Deep brain stimulation (DBS) is an effective method to treat motor disorders and a powerful tool to study brain function.With the spread of DBS in clinical practice and the development of electrical stimulation and electrical recording in brain function,it's clear that implanting electrodes at different targets in the brain or allowing different contacts of implanted electrodes reaching multiple target nuclei and functional areas can improve the clinical efficacy of DBS;and more useful information than single neuronal electrophysiological records will also be obtained by the combination of multiple neuronal electrophysiological records.In this paper,the application of multitarget DBS and electrophysiological records is briefly reviewed.
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Objective The aim of our study was to establish an endoscopic endonasal transsphenoidal surgical training model, and to examine its application value. Methods The endoscopic endonasal transsphenoidal surgical training models were made.After assessments,the models was used for endoscopic operation training for 8 neurosurgeons with no experiences of endoscopic operation. Results The available operating space of this model is similar to the actual operating space in endoscopic endonasal transsphenoidal surgery. The egg fixed on the model has many layers of structure, such as eggshell, shell membrane, egg white and egg yolk, which constituted a good practice object. All students indicated that they could benefit from the training using this model. The skill in grinding the eggshell [(1.07 ± 0.221)cm2/min vs.(1.45±0.27)cm2/min, P<0.001]was significantly improved and the chance for shell membrane rupture (8 vs. 2, P=0.007) was significantly reduced in the last-time practice compared with the first-time practice (P<0.001). Conclusion The endoscopic endonasal transsphenoidal surgical training model is helpful for neurosurgeons to practice the basic operation of endoscopic surgery and to improve their surgical skills,and can be used repeatedly.It can be used in basic operation training before the training using cadaver cranium.
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Objective To investigate the distance change of bilateral internal carotid artery in acromegalic patients. Methods Twenty patients with acromegaly were included in this study from August 2016 to March 2018 in Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University. There were 7 males and 13 females with an average age of 40.2±12.6 years (range from 21 to 62 years old). Forty sex and age matched patients with non-functional pituitary adenoma were selected as controls. The 3D printing software was used for reconstructing the internal carotid artery. Distances of the bilateral internal carotid arteries were measured on the reconstructed images. Results The maximum distance between bilateral siphon carotid ectasias (25.1±3.9 mm vs. 23.2±2.9 mm, P=0.041) and distance between bilateral lacerum segments (26.2 ±3.1 mm vs. 23.8 ±4.1 mm, P=0.022) were significantly longer in patients with acromegaly than in those without. Although the distance between bilateral cavernous segments (20.7 ±4.3 mm vs. 22.4 ±3.1 mm, P=0.076) tended to be shorter, the difference was not statistically significant. The distance between bilateral ophthalmic segments was not significantly different between the two groups (15.7±5.1 mm vs. 16.0±2.5 mm, P=0.783). Conclusion The distance of bilateral internal carotid artery of acromegalic patients is different from that of patients with non-functional pituitary adenomas. Patients with acromegaly have significantly longer distance between bilateral siphon carotid ectasias and distance between bilateral lacerum segments compared with the patients with non- functional pituitary adenomas.
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Objective To study the risk factors of the biochemical remission of pituitary tumor patients with acromegaly treated by the endoscopic endonasal surgery. Methods A retrospective analysis of clinical data was conducted on 61 cases acromegaly patients underwent endoscopic endonasal surgery between August 2013- November 2016.Endocrinology tests were performed in all patients,including the fasting/random GH(growth hormone,GH)level, Nadir GH during OGTT(oral glucose tolerance test, OGTT), and IGF-1(insulin-like growth factor-1,IGF-1). The clinical data included gender, age, preoperative GH value, preoperative IGF-1 value, tumor invasion of the inferface space of internal carotid artery(ICA),tumor surrounding angle of internal carotid artery(≥/<135°),Knosp grade, Hardy grade, and tumor volume. Univariate analysis and multivariate Logistic retrospective analysis were used to analyze the association between above-mentioned factors and the occurrence of biochemical remission. Results There were 52.5% (32/61)patients achieving biochemical remission.Univariate analysis showed significant differences between patients with and without biochemical remission in preoperative GH value, tumor surrounding angle of internal carotid artery(</≥135°)and Knosp grade(P<0.05).The Logistic regression analysis showed that preoperative GH value,tumor surrounding angle of internal carotid artery(</≥135°)were risk factors concerning about the biochemical remission in patients underwent endoscopic endonasal surgery.(P<0.05). Conclusion Tumor surrounding angle of internal carotid artery(≥135°)is independent risk factors, while the preoperative GH value is a risk predictor of biochemical remission after endoscopic endonasal surgery in acromegaly.
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Objective To explore the clinical features,differential diagnosis,preoperative imaging and microsurgical treatment skills/experiences of falcotentorinal meningiomas.Methods Nine patients with falcotentorinal meningiomas,admitted to and performed microsurgical resection in our hospital from January 2009 to October 2015,were chosen in our study.Preoperative examinations included MR imaging and CT angiography:the Galen's veins were totally occluded in two patients and stenosed of different degrees in 7 patients;3 patients had meningiomas at the above of Galen's veins,and 6 under the Galen's veins.Seven patients were resected via Poppen approachs,and 2 with considerable lateral extensions tumors were via bilateral Poppen approach.Results Simpson Grade Ⅰ-Ⅱ tumor resection was achieved in 7 patients and Grade Ⅲ in two patients.Postoperative complications included cortical blindness in two patients recovering within 3 months of follow-up,intracranial infection in one patient curing two weeks later;no postoperative death or severe disabilities were noted.Clinical follow-up was available in 9 patients for a period ranging from 0.5 to 7 years:7 patients enjoyed Simpson Grade Ⅰ-Ⅱ resection had no tumor recurrence and were self-reliable;in two patients with Simpson Grade Ⅲ resection,one accepted postoperative treatment of Gamma knife,another one without other treatment,and these two patients had no tumor progression in the 28 months of follow-up.Conclusion The microsurgery is preferred in the resection of falcotentorinal meningiomas,and sufficient preoperative imaging evaluation,reasonable operation concept,technique and experience of adept micromanipulation are the keys to the safe and effective removal of the tumors.
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Objective To observe the expressions of brain derived neurotrophic factor (BDNF) and tropomyosin-related kinase B (TrkB) in rats with early brain injury (EBI) after subarachnoid hemorrhage,and study the neuroprotective effects of BDNF and TrkB on EBI.Methods Male Sprague-Dawley rats (n=56),weighing 280-320 g,were randomly divided into sham-operated group and SAH group;SAH models were established by endovascular perforation ofinternal carotid artery.At 24 and 72 h after modeling,neurological scale scores were recorded;brain water content was measured;immunohistochemical staining and ELISA were used to observe the dynamical expressions of BDNF and TrkB in the brain.Results At 24 and 72 h after modeling,the neurological function scores and brain water content of SAH rats were higher than those of sham-operated group.The expression scores of BDNF in the SAH rats were 1.33±0.52 and 1.67±0.52,and the expression levels were (12.11±0.44) mg/mL and (15.82±0.89) mg/mL;the expression scores of TrkB were 1.17±0.75 and 2.00±0.00,and the expression levels were (18.89±0.38) mg/mL and (25.18±0.68) mg/mL.The expression scores of BDNF in the sham-operated group were 0.33±0.52 and 0.17±0.41,and the expression levels of BDNF in the sham-operated group was (4.92±0.16) mg/mL and (4.93±0.20) mg/mL;the expression scores of TrkB were 0.17±0.41 and 0.33±0.52,and the expression levels were (8.52±0.41) mg/mL and (8.08±0.34) mg/mL.There were significant differences in BDNF and TrkB expressions between the two groups at 24 and 72 h after modeling (P＜0.05).Conclusion The expressions of BDNF and TrkB increase significantly after SAH,and BDNF and TrkB play protective effect on EBI after SAH.
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To investigate influence of butylphthalide injection on serum neuron specific enolase, C-reactive protein and fatty acid binding protein levels in patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage.Methods Ninety patients with cerebral vasospasm were admitted to The First Affiliated Hospital of Fujian Medical University, then the patients were divided into two groups: The control group (45 patients) was treated with nimodipine and triple-H therapy after surgery;in addition to nimodipine and triple-H therapy, butylphthalide injection was administered to the experimental group(45 patients).Transcranial doppler(TCD)was used for the evaluating cerebral artery blood flow velocity, and the serum neuron specific enolase(NSE), C-reactive protein(CRP) and fatty acid binding protein(FABP) levels in patients with cerebral vasospasm were measured. Results The experimental group improved significantly more than the control group, a significant decrease in cerebral blood flow velocity of the middle cerebral artery in the experimental group as measured by TCD (P<0.05).The serum levels of NSE, CRP and FABP in the patients in the experimental group decreased more significantly (P<0.05).And the incidence of cerebral infarction in experimental group was lower than that in control group (P<0.05).Conclusion The serum levels of NSE, CRP and FABP in the patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage could be significantly reduced by administration of butylphthalide injection, which also could improve cerebral blood supply.Therefore, administration of butylphthalide injection is an effective treatment for cerebral vasospasm.
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Objective To summarize the preliminary experience of endovascular recanalization in treating chronic symptomatic internal carotid artery occlusion.Methods Four patients with chronic symptomatic internal carotid artery occlusion,admitted to and underwent endovascular recanalization in our hospital from August 2013 to August 2014,were chosen in our study; their clinical data were retrospectively analyzed.Results Four patients were successfully opened the internal carotid arteries;cerebral CT angiography showed that all arteries were unobstructed.One appeared intra-operative iatrogenic internal carotid artery cavernous sinus fistula,and successful occlusion of the fistula with internal carotid artery patency was achieved after one week.Three months after the operation,two showed unobstructed internal carotid artery by DSA and the other stated no abnormalities during the telephone follow up.Conclusion Endovascular recanalization is a safe and effective treatment method for chronic symptomatic internal carotid artery occlusion.
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Objective To investigate the changes of perioperative blood glucose in patients with ruptured intracranial aneurysms under keyhole clipping and their prognostic influence factors.Methods Totally, 147 patients with ruptured intracranial aneurysms, admitted to our hospital from July 2010 to July 2012, were selected.The changes of serum glucose on admission and at non-fasting state every day at the hospital, random blood sugar before operation and one day after the operation were analyzed;modified Rankin scale (mRS) was performed to evaluate short-term prognosis of the patients 14 day after the operation;Logistic regression analysis was used to analyze the prognostic influence factors of ruptured intracranial aneurysms under keyhole clipping.Results In the 147 patients with ruptured intracranial aneurysms, 57 (38.8％) had preoperative increased blood glucose and 99 (67.3％) had postoperative increased blood glucose;77 patients had ratio of postoperative/preoperative blood glucose＜1.2, 38 had ratio=1.2-1.5, and 32 had ratio ≥ 1.5.Seventy-eight patients had a good prognosis, while 69 patients gained a poor prognosis.As compared with the good prognosis group, the poor prognosis group had significantly larger percentage of patients with age elder than 60 or with postoperative blood glucose＞7.0 mmol/L, higher Hunt-Hess scale scores and ratio of postoperative/preoperative blood glucose, with significant differences (P＜0.05);multi-factor unconditional Logistic regression analysis indicated that age, postoperative and preoperative blood glucose ratio, postoperative blood glucose and Hunt-Hess scale scores were the independent factors of prognosis.Conclusion In patients with age＞60, Hunt-Hess scale Ⅳ or Ⅴ, postoperative blood glucose＞7.0 mmol/L and postoperative/preoperative blood glucose ratio ≥ 1.5, poor prognosis can be predictive.
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Objective To establish the xenotransplanted tumor model of Craniopharyngioma in chick chorioallan?toic membrane (CAM) and detect the angiogenesis ability, microvessel density (MVD) and cell proliferation of the xeno?graft. Method Craniopharyngioma tissues from surgical craniopharyngioma patients were transplanted on the CAM. An?giogenesis assay was performed and the MVD and PCNA were evaluated using immunohistochemistry following the trans?plantation. Results The tumor formation rate of adamantinomatous craniopharyngioma (ACP) and squamous papillary cra?niopharyngioma (SPCP) was 47.14% and 43.33%, respectively. There was no significant difference in tumor formation rate between ACP and SPCP(χ2=0.123,P=0.726). The CAM angiogenesis, MVD and expression of PCNA were higher in ACP than in SPCP. The expression of PCNA was positively correlated with MVD (Pearson r=0.639,P<0.001) and CAM assay score (Spearman r=0.490,P=0.001 ) in CP. Conclusion The model of human craniopharyngioma can be es?tablished in the CAM. The angiogenesis of the xenograft in the CAM can be evaluated and the craniopharyngioma xeno?graft of CAM possesses a new blood circulation and cell proliferation ability.
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Objective To explore the influence of peritumoral edema (PTE) on the tendency of recurrent location and morphological character after total resection using MRI. Methods MRI data was collected from 43 patients with recur-rent brain glioma after total resection from four clinical centers and then the influence of of PTE on recurrence patterns af-ter total resection was retrospectively analyzed based on the T2 weighted image. Results The PTE had a significant influ-ence on the recurrent patterns of brain gliomas after total resection. When PTE was mild, the shapes of recurrent gliomas tended to be focal (6/8) and the recurrent locations tended to be local (5/8). When PTE was severe, the shapes of the recur- rent gliomas tended to be spread(30/35 and the recurrent locations tended to be distant (25/35), followed by marginal (7/35), In addition, the morphological patterns and locations of recurrent gliomas were significantly different among different PTE types (all P<0.001). When PTE was ring shape, the shapes of recurrent gliomas tended to be focal (7/9) and the recur-rent locations tended to be local (6/9), followed by marginal (2/9) and distant (1/9). When PTE was irregular shape, most of recurrent locations tended to be distant (25/34), followed by marginal (7/34) but rarely local (2/34). Conclusions The de-grees and the types of brain glioma PTE can significantly influence the locations and morphological patterns of recurrent gliomas after total resection.
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Objective The purpose of this study was to assess the imaging features of newly diagnosed high-grade glioma and the effect of relevant factors such as postoperative radiotherapy and chemotherapy on progression-free sur-vival (PFS) time. Methods A total of 54 patients with recurrent high-grade glioma confirmed by pathology or progressive malignant glioma proved by clinical follow-up were included in this retrospective study from 4 clinical centers. The prog-nostic factors selected included MR image features at initial diagnosis (including the maximum diameter of tumor, peritu-moral edema, degree of enhancement, degree of necrosis and presence of cystic or satellite), postoperative radiotherapy and chemotherapy. Kaplan-Meier method and Cox’s proportion-hazards model were used to analyse the factors influenc-ing the progression free survival (PFS) time. Results The univariate Kaplan-Meier analysis revealed that the degree of peritumoral edema (PTE, P=0.001), degree of necrosis (P<0.001) , degree of enhancement (P<0.001), postoperative radio-therapy (P=0.008) and chemotherapy(P=0.035) were significant factors for PFS. Cox multivariate analysis also showed that the degree of PTE(P=0.019),degree of necrosis (P<0.001) were all significantly correlated with PFS. The less edema or necrosis was associated with the longer PFS. In addition, postoperative radiotherapy (P=0.035) and chemotherapy (P=0.049) were also significantly correlated with PFS. The normative chemotherapy and radiotherapy were associated with longer PFS. Conclusions The PTE and necrosis on preoperative MR images can be used to predict the PFS of glioma af-ter total resection. Adjuvant normative chemotherapy and radiotherapy should be recommend for supratentorial high-grade glioma including those even with MRI confirmed total resection.
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Background Although remarkable progress has been made in microsurgery, surgery of intracranial aneurysm still encounters various complications. Cerebral ischemia and postoperative disorders of nervous system could be induced by various specific operation procedures. To improve the outcomes in intracranial aneurysm surgery and to minimize the occurrence of postoperative ischemic complications, it is necessary to perform real-time monitoring on ischemic damages for the corresponding functional areas. To elevate the sensitivity of Eps changes for the detection of cerebral ischemia induced by operation, we monitored Motion Evoked Potential ( MEPs), Somatosensory Evoked Potential (SSEPs)and Brainstem Auditory Evoked Potential (BAEPs) in microsurgical operations of intracranial aneurysms. And then the correlation between Eps changes and clinical outcome was investigated.Methods MEPs, SSEPs, and BAEPs were recorded intra-operatively for 25 cases in intracranial aneurysms. Monitored results and clinical outcome were analyzed in a prospective observational design.Results The MEPs in 5 of 21 cases, the SSEPs in 5 of 25 cases and the BAEPs in 1 of 3 cases showed inadequate temporary clipping, inadvertent occlusion, inadequate retraction, vasospasm, or compromise to perforating vessels. 3 patients developed advanced weakness, which showed abnormal SSEPs in only one patient while showed abnormal MEPs in all 3 cases.Conclusions The MEPs is more sensitive than SSEPs in monitoring the motor ischemic impairments. The monitoring results were correlated to the clinical outcome closely. Monitoring Eps in keyhole microsurgery of intracranial aneurysms could improve the sensitivity in detecting insufficient distal collateral flow. And then successful completion of potentially hazardous maneuvers would be attained.
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Objective To investigate the efficacy of MSCs infused intravenously on the regeneration of injured spinal cord and rehabilitation of its neurological function. Methods 32 SD rats, male or female, weight about 300 g for each one. MSCs were separated, cultured and purified in vitro. Surface marker of MSCs, such as CD34, CD45, CD29 and CD90 were detected by flow cytometry. The rat spinal cord injury model was prepared according to the modified Allen method. After exposure of T10 spinal cord, the T10 segment of spinal cord was injuried by a 10 g weight falling down from 5 cm high place upon a round thin copper pad which was placed on the surface of T10 segment of spinal cord. The diameter of the copper pad is 3 mm. There are 24 rats in the injuried group and 8 in the non-injuried group. The injuried group was then divided into experiment group with 14 rats and control group with 10 rats at 24 hours after preparation of models. The rats in the injuried group and non-injuried group were infused with MSCs marked by Brdu through tail vein, and the rats in control group were infused with PBS. The neurological functions of rats were evaluated at 24 hours after injury and 1, 3, 5 weeks post-infusion respectively. At the same time, the immigration, survival and differentiation of MSCs were observed. Results The MSCs were uniformly CD29, CD90 positive and CD34, CD45 negative. In vivo experiment, transplanted MSCs survived and were localized to the injured spinal cord, and a few cells expressed NSE, MAP2 post transplantation 3 to 5 weeks. Significant improvement in functional outcome in rats treated with MSCs transplantation compared to control rats. The score of BBB in the treated group was higher than that in the control group (P